Compilation of the Social Security Laws

FRAUD AND ABUSE CONTROL PROGRAM

(1) In
general.—Not later than January 1, 1997,
the Secretary, acting through the Office of the Inspector General
of the Department of Health and Human Services, and the Attorney General
shall establish a program—

(A) to coordinate
Federal, State, and local law enforcement programs to control fraud
and abuse with respect to health plans,

(B) to conduct
investigations, audits, evaluations, and inspections relating to the
delivery of and payment for health care in the United States,

(C) to facilitate
the enforcement of the provisions of sections 1128, 1128A, and 1128B and other statutes applicable to
health care fraud and abuse, and

(D) to provide
for the modification and establishment of safe harbors and to issue
advisory opinions and special fraud alerts pursuant to section 1128D, and

(2) Coordination
with health plans.—In carrying out the
program established under paragraph (1), the Secretary and the Attorney
General shall consult with, and arrange for the sharing of data with
representatives of health plans.

(A) In general.—The Secretary and the Attorney
General shall issue guidelines to carry out the program under paragraph
(1). The provisions of sections 553, 556, and 557 of title 5, United
States Code, shall not apply in the issuance of such guidelines.

(i) In
general.—Such guidelines shall include
guidelines relating to the furnishing of information by health plans,
providers, and others to enable the Secretary and the Attorney General
to carry out the program (including coordination with health plans
under paragraph (2)).

(ii) Confidentiality.—Such guidelines shall include procedures to assure that such
information is provided and utilized in a manner that appropriately
protects the confidentiality of the information and the privacy of
individuals receiving health care services and items.

(iii) Qualified immunity for providing information.—The provisions of section 1157(a) (relating to limitation on
liability) shall apply to a person providing information to the Secretary
or the Attorney General in conjunction with their performance of duties
under this section.

(4) Ensuring
access to documentation.—The Inspector
General of the Department of Health and Human Services is authorized
to exercise such authority described in paragraphs (3) through (9)
of section 6 of the Inspector General Act of 1978 (5 U.S.C. App.)
as necessary with respect to the activities under the fraud and abuse
control program established under this subsection.

(5) Authority
of inspector general.—Nothing in this
Act shall be construed to diminish the authority of any Inspector
General, including such authority as provided in the Inspector General
Act of 1978 (5 U.S.C. App.).

(1) Reimbursements
for investigations.—The Inspector General
of the Department of Health and Human Services is authorized to receive
and retain for current use reimbursement for the costs of conducting
investigations and audits and for monitoring compliance plans when
such costs are ordered by a court, voluntarily agreed to be the payor,
or otherwise.

(2) Crediting.—Funds received by the Inspector General under paragraph (1)
as reimbursement for costs of conducting investigations shall be deposited
to the credit of the appropriation from which initially paid, or to
appropriations for similar purposes currently available at the time
of deposit, and shall remain available for obligation for 1 year from
the date of the deposit of such funds.

(c) Health
Plan Defined.—For purposes of this section,
the term “health plan” means a plan or program that provides
health benefits, whether directly, through insurance, or otherwise,
and includes—

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